By Andie Burjek
Aug. 28, 2020
COVID-19 has highlighted the importance of treating health care workers well. A population of employees that was already at high risk of burnout, the pandemic has added even more pressure on certain medical professionals who must endure higher workloads, abide by stricter reporting and safety routines, and witness the carnage of a pandemic.
Nurses are one group of these medical workers. Even before COVID-19, burnout among nursing staff was a concern, with one 2017 study finding that nearly 50 percent of nurse respondents saying they have considered leaving the field for reasons such as feeling overworked, being swamped with paperwork and not feeling satisfied with their job.
Best practices to keep nursing staff engaged include deciding the right shift length for your workforce, hiring the right number of full-time versus part-time employees and determining if centralized or decentralized scheduling in nursing works for your organization.
Centralized versus decentralized scheduling in nursing
With a centralized model, the organizations manage staffing and scheduling through one central office, while with a decentralized model, these decisions are made as an individual hospital or unit.
The decision between centralized and decentralized scheduling in nursing is partly based on geography and if the hospital system exists in one city versus many time zones, said Matt Stevenson, partner and leader of Mercer’s Workforce Strategy and Analytics practice. A centralized model can work for a location or several locations in one city. It allows two locations from the same hospital system to use the same centralized staffing pool, and nurses can potentially move from one location to another instead of getting sent home if they’re scheduled for an overstaffed shift.
There are also efficiencies in terms of how payroll. Financials and training are handled the same way across locations, he added.
However, this may not work if an employee has to drive long distances to get from one location to another, he said. That’s why a decentralized model may work better for a hospital system that is multistate, rural or widely spread out.
In addition, from the cultural perspectives, many hospitals don’t prefer a centralized model because they’d have less control and they’d be at the mercy of a centralized system for staffing needs, Stevenson said. If they don’t get extra staff that way, they’re out of luck. A decentralized model provides more independence.
Forecasting patient census
There are different types of hospitals that may have different scheduling concerns, but one challenge they share is that they can’t predict how many patients come through the door in a given day or how sick they’ll be, Stevenson said. While hospitals can depend on some big-picture trends, they aren’t always reliable, which causes a lot of stress internally.
If nurses are understaffed, that may mean that nurses are overwhelmed and overworked. If nurses are overstaffed, that may mean having to send people home without working or getting paid.
Systems are getting more sophisticated about forecasting patient census — how many patients are expected to come in during a given time period, Stevenson said. And those hospitals and health systems that do it better will help the morale of nurses and other health care workers, he added.
Scheduling and managing full-time versus part-time nurses
Nursing organizations fall onto different parts of the continuum of mostly full-time employees versus mostly part-time employees, and having more of either can be advantageous for different companies, Stevenson said.
Full-time nurses generally stay at an organization longer, but hospitals must pay them more and give them a full-time schedule. Using more part-time nurses means more flexibility in the schedule but can also mean more turnover.
The challenge here is that each supports competing priorities — one financial and one operational, Stevenson said.
“Finding the sweet spot of the right mix between full time and part time is really tough, and we find it different for every hospital,” he said. “Those organizations that can figure out the sweet spot will win every time.”
For hospitals trying to figure this out, the first aspect to consider is what the labor market looks like in the area. Are there more full-time or part-time options available?
Second, it depends on how the hospital is set up and how many recruiters and trainers there are on staff. With more part-time employees, there will need to be enough people to find, interview, hire, and train talent. A hospital may not be able to change the full-time to part-time ratio if the staff infrastructure of the organization does not support that new mix.
Finally, it depends on how a hospital sets up its nurses’ shifts. Are they mostly six hour, eight hour, or 12-hour shifts? If a nurse works many shorter shifts, they tend to be part-time.
How to set up nursing shifts
The length of shifts depends on factors such as the type of care nurses are providing and the age of the workforce, Stevenson said. In general, younger workers are more open to 12-hour shifts. Also, employees start to get burned out at hour 12, so caring for high-acuity patients with challenging medical conditions and unpredictable needs may not be the best option for them.
On the other extreme, four or six hour shifts present more opportunities for infectious disease to spread, he said. If a patient has something infectious, the fewer number of nurses who care for them in a given day, the less likely that will spread their infection to more people.
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